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General NPI Number Information
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NPI Number | 1992328678
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Entity Type | Individual
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Provider Name | MADISON BREANNE NIGUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 5844 NW BARRY RD STE 120
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City | KANSAS CITY
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State | MO
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Zip | 64154-1483
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Country | US
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Telephone | 816-472-9595
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Fax | 816-472-1132
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST MAILSTOP 400
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City | KANSAS CITY
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State | MO
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Zip | 64131-4517
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Country | US
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Telephone | 816-599-9499
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Fax | 816-932-9670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2020039368
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License Number State | MO
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